Efficacy of Intramyocardial Injection of Angiogenic Cell Precursors for Ischemic Cardiomyopathy

Abstract

<jats:sec><jats:title>Introduction</jats:title><jats:p> The objective of this study is to determine the efficacy of intramyocardial angiogenic cell precursors (ACPs) injection in ischemic cardiomyopathy (ICM). </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Twenty-five ICM patients (cell group) underwent intramyocardial ACPs injection. Seventeen ICM patients (control group) treated by medical means were matched with cell group. There was no statistically significant difference between cell and control groups in relation to left ventricular ejection fraction (LVEF) and comorbidities. In the cell group, mean age was 58.4 ± 13.7 years. Mean LVEF was 26.1% ± 7.4%. New York Heart Association (NYHA) class was 2.9 ± 0.6. The ACPs were derived and expanded from autologous blood. The number of cells before injection was 27.4 ± 18.8 million cells. The cells were injected into the nonviable myocardium and hypokinetic segments in the cell group. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> There was no new ventricular arrhythmia. NYHA was improved by 0.9 ± 1.0 (P &lt; 0.001) at 229.9 ± 98.8 days. Six-minute walk test and quality of life assessed by short form-36 improved in the cell group. LVEF was improved in 72% of patients (18 of 25). LVEF improved by 6.4 ± 9.9 points % (P = 0.003) at 290.4 ± 210.3 days. The percentage of infarction area decreased 21.9 ± 17.4 points % at 159 ± 54 days postoperatively. There was no significant improvement of NYHA and LVEF in the control group. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> For this efficacy study, the NYHA class, quality of life, and six-minute walk test were improved after cell transplantation. The LVEF was also significantly improved in the cell treated group. </jats:p></jats:sec>

Stem Cell Therapy Combined with Myocardial Revascularization: A Pilot Study using the Harvest Technique

“…These results confirms those of many previous trials including Arom et al [10] who reported improvement in NYHA class from preoperative of 2.9 ± 0.7 to postoperative of 2.0 ± 0.9 (P <0.001) [10]. Group A patients showed significant improvement in LVEF in postoperative echocardiography and DSE compared to non-significant improvement in group B patients.…”

“…Furthermore, it has shown that ABM-MNCs isolated from those patients have a significantly reduced migratory and colony-forming activity in vitro and a reduced neovascularization capacity in vivo despite similar content of hematopoietic stem cells [16]. Different cellular implantation techniques have been performed including transepicardial [1,[9][10][11][12], selective intracoronary infusion [2][3][4] percutaneous transfemoral endoventricular [5,6] or coronary venous routes [8]. Each of these delivery methods has its distinct advantages and limitations and no single approach has gained favor as the optimal technique for cell transplantation.…”

“…Stem cell therapy may represent the hope for those types of patients [1][2][3][4][5][6][7][8][9][10][11][12]. Several studies discussed this promising therapy with different techniques and routes including surgical transepicardial (intramyocardial injection) [1,[9][10][11][12], selective intracoronary artery infusion [2][3][4], percutaneous transfemoral endoventricular (catheter-based transendocardial injection) [5,6] or retrograde coronary venous [8]. Here in, we aimed to assess the usefulness of intra-myocardial autologous stem cell injection as a hybrid procedure with CABG compared to conventional CABG only in those patients with ischemic heart disease with non-viable or non-graftable myocardial segments.…”

Critical elements in the development of cell therapy potency assays for ischemic conditions

“…An array test showing that the cells secreted IL-8, VEGF and angiogenin was used to assess the product potency and later to narrow the range of tested cytokines to IL-8, which was subsequently used as a release test for the CTP [23]. Validation of the surrogate markerebased tests was achieved when the CTP was tested and shown to be effective in an in vivo rat model of ischemic cardiomyopathy [24] and in human patients with ischemic and non-ischemic cardiomyopathy [25,26] (Figure 3).…”

Stem Cell Therapy in Myocardial Infarction Clinical Point of View and the Results of the REANIMA Study (REgenerAtion of Myocardium with boNe Marrow Mononuclear Cells in MyocArdial Infarction)

“…Very interesting non-randomized, case control study comes from Thailand's group, who used thoracoscopic delivery of in-vitro expanded endothelial progenitors (EPC) isolated from the peripheral blood into the peri-infarction area (Arom et al, 2008). The subset of patients received combined EPC therapy with off-pump CABG.…”